Should I be worried about bipolar disorder?
February 18, 2018 3:02 PM Subscribe
I'm studying bipolar disorder in my clinical psych program and getting a little bit of med student syndrome, except in a prospective "oh god what if this happens to me" kind of way. The problem is I have family history that places me at risk. Please either a) reassure me, or if I am actually at significant risk, b) tell me what I can do proactively to keep an eye on any developing symptoms.
My grandmother had bipolar disorder and was on lithium pretty much her entire life. It was very hard on her health and she passed away a lot sooner than she likely would have because of it. Previously I had assumed that bipolar disorder was something that manifested in teens or very early twenties; since I'm 24 I figured I was pretty much in the clear. Unfortunately, now that I'm learning more about it, it turns out I haven't even hit the average age of onset. Now I'm getting anxiety about BD coming out of the blue and wrecking my life.
I don't think I've ever had any symptoms of mania or hypomania, but I did have a depressive episode in my late teens. However, a significant portion of that was from being in an abusive household; once I left, I recovered and have not had any depressive symptoms since. I assumed that if I were going to have any manic episodes they would have happened by now, or at least that I would show either depressive or manic symptoms. I thought that since I've been exceptionally stable in mood for the last 5 years, that the likelihood of developing BD was pretty much nil. Now I'm not so sure.
Am I being anxious over nothing? Are there usually mood symptoms prior to the first episode (or, I suppose if you consider my teenage episode to be the first episode, between episodes)? Or can it really come totally out of the blue like that?
What is the general course? And if it is something that I'm still at significant risk for developing, are there any warning signs should I look out for? Not in a "I'm going to micromanage and overanalyze my life" kind of way, but just things I should keep an eye out for that I might not otherwise pay attention to.
I don't usually get anxiety over potentially having/developing an illness, and the fact that my grandma had it + she passed away last year is probably just making me blow it out of proportion. But I'd like a sanity check nonetheless.
My grandmother had bipolar disorder and was on lithium pretty much her entire life. It was very hard on her health and she passed away a lot sooner than she likely would have because of it. Previously I had assumed that bipolar disorder was something that manifested in teens or very early twenties; since I'm 24 I figured I was pretty much in the clear. Unfortunately, now that I'm learning more about it, it turns out I haven't even hit the average age of onset. Now I'm getting anxiety about BD coming out of the blue and wrecking my life.
I don't think I've ever had any symptoms of mania or hypomania, but I did have a depressive episode in my late teens. However, a significant portion of that was from being in an abusive household; once I left, I recovered and have not had any depressive symptoms since. I assumed that if I were going to have any manic episodes they would have happened by now, or at least that I would show either depressive or manic symptoms. I thought that since I've been exceptionally stable in mood for the last 5 years, that the likelihood of developing BD was pretty much nil. Now I'm not so sure.
Am I being anxious over nothing? Are there usually mood symptoms prior to the first episode (or, I suppose if you consider my teenage episode to be the first episode, between episodes)? Or can it really come totally out of the blue like that?
What is the general course? And if it is something that I'm still at significant risk for developing, are there any warning signs should I look out for? Not in a "I'm going to micromanage and overanalyze my life" kind of way, but just things I should keep an eye out for that I might not otherwise pay attention to.
I don't usually get anxiety over potentially having/developing an illness, and the fact that my grandma had it + she passed away last year is probably just making me blow it out of proportion. But I'd like a sanity check nonetheless.
Best answer: So, I'm a person with a super-strong history of bipolar disorder in my family, and I totally get your pain on this. I do have major depression that I will be on medication for for the rest of my life, and I'm really at peace with that. Quick thoughts of what helped me when I was freaking out about this:
1. You are almsot at the median age of onset. And some studies do show an average age of onset of 21. You are honestly almost out of the clear, though I will tell you that once I hit 30 I felt really relieved - while I recognize it can happen at any age, the odds are significantly lower now.
2. Talking to a therapist about this was really helpful, and especially understanding survivor's guilt related to this - both of my siblings have bipolar disorder. I think having a therapist who I could be honest with and have them be like, "This doesn't seem like a manic episode" was really reassuring and comforting for me.
3. If you do develop bipolar disorder, it will suck. But you will have the tools to manage it, and you will be able to seek help if it happens.
4. TLDR: you are probably more anxious than necessary, but it also is super-understandable. So much support heading you way.
posted by superlibby at 3:41 PM on February 18, 2018 [8 favorites]
1. You are almsot at the median age of onset. And some studies do show an average age of onset of 21. You are honestly almost out of the clear, though I will tell you that once I hit 30 I felt really relieved - while I recognize it can happen at any age, the odds are significantly lower now.
2. Talking to a therapist about this was really helpful, and especially understanding survivor's guilt related to this - both of my siblings have bipolar disorder. I think having a therapist who I could be honest with and have them be like, "This doesn't seem like a manic episode" was really reassuring and comforting for me.
3. If you do develop bipolar disorder, it will suck. But you will have the tools to manage it, and you will be able to seek help if it happens.
4. TLDR: you are probably more anxious than necessary, but it also is super-understandable. So much support heading you way.
posted by superlibby at 3:41 PM on February 18, 2018 [8 favorites]
Watch out for feeling super good, impulsive behavior and too much energy. And if you do, run to a psychiatrist appointment.
posted by starlybri at 3:42 PM on February 18, 2018 [6 favorites]
posted by starlybri at 3:42 PM on February 18, 2018 [6 favorites]
Best answer: I am not in your position. My bipolar disorder began in childhood. But the negative effects of it were mainly felt when it was uncontrolled and mistreated.
My matrilineal line has issues with depression, and though I'm the only one diagnosed with bipolar, I suspect some of my forebears had it, too. There are lots and lots of options for treatment now. Lithium is no longer the only thing, and as I understand it (the last time I took lithium was going on 20 years now) even that is safer now with lower doses and better monitoring. My current regimen of an antipsychotic plus an SSRI has kept me stable for a few years now, with tolerable side effects.
I guess all of this is to say, worrying about it won't change if you get it. Be aware of warning signs (especially of hypomania) because spending all your money or sleeping with everyone in sight can fuck up your life, and do smart things like warning a doctor who suggests SSRIs of your family history. And yeah, it's serious, and it fucked up my life real good a few times. But there is a lot of help out there if you end up with it.
If it helps, I think jbenben's suggestion of an evaluation would help put your mind at ease. And I'm happy to talk about it any time if you memail me.
posted by fiercecupcake at 3:43 PM on February 18, 2018 [4 favorites]
My matrilineal line has issues with depression, and though I'm the only one diagnosed with bipolar, I suspect some of my forebears had it, too. There are lots and lots of options for treatment now. Lithium is no longer the only thing, and as I understand it (the last time I took lithium was going on 20 years now) even that is safer now with lower doses and better monitoring. My current regimen of an antipsychotic plus an SSRI has kept me stable for a few years now, with tolerable side effects.
I guess all of this is to say, worrying about it won't change if you get it. Be aware of warning signs (especially of hypomania) because spending all your money or sleeping with everyone in sight can fuck up your life, and do smart things like warning a doctor who suggests SSRIs of your family history. And yeah, it's serious, and it fucked up my life real good a few times. But there is a lot of help out there if you end up with it.
If it helps, I think jbenben's suggestion of an evaluation would help put your mind at ease. And I'm happy to talk about it any time if you memail me.
posted by fiercecupcake at 3:43 PM on February 18, 2018 [4 favorites]
From previous questions, you've had a partner for awhile? Ask them to let you know if they see changes in you that might be consistent with bipolar. Reckless activity especially - abnormal spending, driving too fast, substance abuse, not sleeping, etc.
My mom has it, her father had it, his mother had it, and I don't. You're not doomed. I've told every therapist my family history and none have suspected that I have it. And honestly, my mom had some rough periods when I was a kid, but she's been medicated for the last couple decades and is living a full life. She has a job and a husband and friends and hobbies. Psychiatry has advanced since she was diagnosed. It's not a death sentence.
posted by AFABulous at 4:28 PM on February 18, 2018 [4 favorites]
My mom has it, her father had it, his mother had it, and I don't. You're not doomed. I've told every therapist my family history and none have suspected that I have it. And honestly, my mom had some rough periods when I was a kid, but she's been medicated for the last couple decades and is living a full life. She has a job and a husband and friends and hobbies. Psychiatry has advanced since she was diagnosed. It's not a death sentence.
posted by AFABulous at 4:28 PM on February 18, 2018 [4 favorites]
You're past the age at which you really need to worry, I think, and many people with BPD can trace sxs back to childhood or their teenaged years. As I always tell pts, someone else will really KNOW when something is wrong with you. (You may not know it yourself.)
For example, you would be up for days and days without being tired. You'll be super productive the entire time and then, months later, back at baseline, you'll realize that you've written a lot of gibberish. You'd buy nine versions of the same sweater "just in case." And remember that mania is the fun part. The depression is so inky and black that you would not have missed it. That you attribute some depressive sxs in the past to situational factors suggests that we're not talking about physiological depression.
posted by flyingfork at 5:54 PM on February 18, 2018
For example, you would be up for days and days without being tired. You'll be super productive the entire time and then, months later, back at baseline, you'll realize that you've written a lot of gibberish. You'd buy nine versions of the same sweater "just in case." And remember that mania is the fun part. The depression is so inky and black that you would not have missed it. That you attribute some depressive sxs in the past to situational factors suggests that we're not talking about physiological depression.
posted by flyingfork at 5:54 PM on February 18, 2018
The comments above are all apt, and speaking as someone who is bipolar, Life does Go On. And it's Pretty Damn Good.
There's nothing you can do about it except practice good physically and mentally health practices.
Obsessing over whether or not you *might* become bipolar is not mentally healthy.
posted by BlueHorse at 7:46 PM on February 18, 2018 [4 favorites]
There's nothing you can do about it except practice good physically and mentally health practices.
Obsessing over whether or not you *might* become bipolar is not mentally healthy.
posted by BlueHorse at 7:46 PM on February 18, 2018 [4 favorites]
Best answer: Hey! So, I developed a cyclic mood disorder at 23 and now I'm 29. I don't have a whole lot of actionable advice because it sounds like your family history is more bipolar-I-type (which I don't have).
It is possible you will develop this disease, or another mood disorder. They are common. Here's my only sage advice: if you do end up having a depressive or manic or anxious episode, please seek treatment immediately. Cyclical mood disorders--especially those with manic/hypomanic features!--can mean that you start to feel better on your own before you've talked to a therapist, so you don't keep searching for the therapist, and then the next time you have an episode you don't have a therapist, which sucks.
And, maybe...
Hm, this is really hard to phrase, but here's what I wish I'd told myself after the first depressive episode, when I wasn't sure if it was going to last forever: health is a temporary state. If you live long enough, you will become disabled; physically, mentally, emotionally. It will suck, and it will make things harder. But life is still often excellent. A mood disorder is not always a death sentence. I am not sorry I stuck it out after I realized this might keep happening; the answer to my frantic 23-year-old question, "how could that be bearable?" is, "it turns out that a whole lot of shit is bearable that you thought wasn't." Your life will grow to fill the space provided. You probably already know that, but I wanted to say it anyway.
posted by peppercorn at 7:47 PM on February 18, 2018 [8 favorites]
It is possible you will develop this disease, or another mood disorder. They are common. Here's my only sage advice: if you do end up having a depressive or manic or anxious episode, please seek treatment immediately. Cyclical mood disorders--especially those with manic/hypomanic features!--can mean that you start to feel better on your own before you've talked to a therapist, so you don't keep searching for the therapist, and then the next time you have an episode you don't have a therapist, which sucks.
And, maybe...
Hm, this is really hard to phrase, but here's what I wish I'd told myself after the first depressive episode, when I wasn't sure if it was going to last forever: health is a temporary state. If you live long enough, you will become disabled; physically, mentally, emotionally. It will suck, and it will make things harder. But life is still often excellent. A mood disorder is not always a death sentence. I am not sorry I stuck it out after I realized this might keep happening; the answer to my frantic 23-year-old question, "how could that be bearable?" is, "it turns out that a whole lot of shit is bearable that you thought wasn't." Your life will grow to fill the space provided. You probably already know that, but I wanted to say it anyway.
posted by peppercorn at 7:47 PM on February 18, 2018 [8 favorites]
Argh, sorry, I did leave the part out of that comment that directly answered your question which was "the warning signs I did experience were only warning signs in retrospect, so there wasn't anything I could've watched for in advance, and it would have made me a lot more anxious." I knew when depression hit for real-- it was not a subtle experience, coming from years of solid mental health-- but the lead-in was not anything like as clear; while now after years of the experience I know what it feels like when my emotional pressure is dropping, I still get a fair number of false positives. So my advice is the same as folks above: practice good health and worry about it when it gets here.
posted by peppercorn at 7:58 PM on February 18, 2018
posted by peppercorn at 7:58 PM on February 18, 2018
Best answer: Hi there. Every male member of my father's family- him, both brothers, grandfather and great grandfather had or have bi-polar disorder. I am female and had no symptoms whatsoever in my life aside from a depression at 21 that stemmed from a break up and another at 29 stemming from a very difficult move across the country.
However, following the birth of my second child, I experienced severe and sudden onset postpartum depression. Because I didn't have any of the symptoms of bipolar disorder, the psychiatrist I saw prescribed Zoloft. The experience I had on it was incredibly frightening, almost out of body.
Based on that family history and my reaction to the SSRI, I'm now being treated with Lamictal and will probably be on it for life. To your question:
1. That is a STRONG family history in my instance. Stronger than in your case. My younger sibling is having a tough time right now and my advice to him was to proceed with caution when it came to SSRIs. I wouldn't wish the experience I had on anyone. Sibling is going to try Wellbutrin instead of Zoloft.
2. In retrospect, I think my two depressive episodes were probably both more severe and longer lasting than your average bear, but in both cases I made a full recovery within a year and in both cases they seemed linked to events for which depression was a reasonable response. If giving advice to someone else, I'd say if you have a family history of bipolar disorder, take those kinds of episodes seriously and as a possible signaling and that while it may not be necessary some level of vigilance is not unreasonable.
3. If you may have children-- I had not been aware that childbirth/PPD could trigger bipolar episodes. I wish that I had known that in advance and perhaps this would not have been so frightening.
4. My father, grandfather, uncles etc. are exceptional men who lead/have led wonderful lives and that's including my granddad who took lithium his whole life and died in his sleep at home at 95. I think I was so worried about getting 'diagnosed' that now that it has finally happened to me at 35. I feel more preoccupied with getting this managed as thoroughly and well as possible and less preoccupied with the label itself.
5. The psychiatrist who I see and like quite a bit basically said that this was a spectrum and that with my family history, the quality of my previous depressive episodes, PPD, and classic reaction to SSRIs I was somewhere on that spectrum but it was not that useful to try to identify exactly where. The important thing was getting great care and support and getting medication figured out.
I hope that this is helpful and best of luck!
posted by jeszac at 10:39 AM on February 19, 2018 [1 favorite]
However, following the birth of my second child, I experienced severe and sudden onset postpartum depression. Because I didn't have any of the symptoms of bipolar disorder, the psychiatrist I saw prescribed Zoloft. The experience I had on it was incredibly frightening, almost out of body.
Based on that family history and my reaction to the SSRI, I'm now being treated with Lamictal and will probably be on it for life. To your question:
1. That is a STRONG family history in my instance. Stronger than in your case. My younger sibling is having a tough time right now and my advice to him was to proceed with caution when it came to SSRIs. I wouldn't wish the experience I had on anyone. Sibling is going to try Wellbutrin instead of Zoloft.
2. In retrospect, I think my two depressive episodes were probably both more severe and longer lasting than your average bear, but in both cases I made a full recovery within a year and in both cases they seemed linked to events for which depression was a reasonable response. If giving advice to someone else, I'd say if you have a family history of bipolar disorder, take those kinds of episodes seriously and as a possible signaling and that while it may not be necessary some level of vigilance is not unreasonable.
3. If you may have children-- I had not been aware that childbirth/PPD could trigger bipolar episodes. I wish that I had known that in advance and perhaps this would not have been so frightening.
4. My father, grandfather, uncles etc. are exceptional men who lead/have led wonderful lives and that's including my granddad who took lithium his whole life and died in his sleep at home at 95. I think I was so worried about getting 'diagnosed' that now that it has finally happened to me at 35. I feel more preoccupied with getting this managed as thoroughly and well as possible and less preoccupied with the label itself.
5. The psychiatrist who I see and like quite a bit basically said that this was a spectrum and that with my family history, the quality of my previous depressive episodes, PPD, and classic reaction to SSRIs I was somewhere on that spectrum but it was not that useful to try to identify exactly where. The important thing was getting great care and support and getting medication figured out.
I hope that this is helpful and best of luck!
posted by jeszac at 10:39 AM on February 19, 2018 [1 favorite]
Response by poster: Thanks all. I think a lot of my anxiety stems from the fact that I have a chronic illness--I know bipolar disorder isn't a death sentence, but I'm barely staying on top of things as it is because of my illness, so adding another one on top of that would probably wreck me for a while (and I still haven't settled on a good medication for that, so trying to figure out a medication for BD as well... not a fun prospect). But I do have people who would notice very quickly if I started showing signs of even hypomania (I mean, hell, I'm in a clinical psych program, it's probably the best place I could be) and you're right that I really don't need to spend so much time thinking about it. I appreciate the reassurances.
posted by brook horse at 4:31 PM on February 19, 2018 [5 favorites]
posted by brook horse at 4:31 PM on February 19, 2018 [5 favorites]
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posted by jbenben at 3:07 PM on February 18, 2018 [4 favorites]